Legislature should override rejection of Maui hospital

THE ISSUE

Gov. Linda Lingle is asking the Legislature to authorize a second acute-care hospital on Maui.

ANTIQUATED criteria strictly followed by the state bureaucracy are blocking plans for a badly needed second hospital on Maui, and legislation is needed to allow the project to proceed. Lawmakers should grant Gov. Linda Lingle's request that they exempt the proposed hospital from the criteria and change the rules to prevent similar snags in the future.

A state health advisory committee recommended approval last summer of a new hospital at Kihei called the Malulani Health and Medical Center. However, a panel of the State Health Planning and Development Agency turned down the application in order to protect the state-run Maui Memorial Medical Center from competition. The panel rejected an appeal a week ago.

The proposed $212 million Malulani hospital would be privately built by a community-based nonprofit organization called Malulani Health Systems and a for-profit Texas-based company, Triad Hospitals Inc.,*
that operates more than 60 hospitals and ambulatory surgery centers on the mainland. The facility would include 150 acute-care beds, 25 critical-care bends, 110 medical or surgical beds and 15 labor, delivery and recovery beds.

Dr. David Sakamoto, the state agency's administrator, has acknowledged "there's no question" that Maui needs more acute-care beds but the panel could not approve the proposal because of the strict criteria required by state law, according to the Maui News.

Perhaps the most important concern has been whether the hospital could be adequately staffed. Malulani's application estimated it would need up to 750 employees. However, Dr. Ron Kwon, president of Malulani Health Systems, assured the state panel that he had "stacks" of job applications from doctors and nurses.

The nursing shortage is severe across the country and especially in Hawaii. However, Lingle and the governor of the Philippines' Ilocos region signed an agreement a year ago for an exchange program that could result in many Philippine nursing graduates filling jobs in Hawaii.

Lingle also is asking the Legislature to increase funding for the University of Hawaii's School of Nursing so it can produce more graduates. Hawaii's nursing shortage is caused largely by a shortage of nursing faculty; nurses make more money than their instructors. The nursing shortage should not result in a freeze on health care.

The bureaucratic morass, called the certificate-of-need process, was adopted nationwide and supported by the federal government during an excess of hospitals in the 1970s and early 1980s. However, the federal endorsement was revoked in 1986 because of what had become a hospital shortage, and a dozen states have revoked the requirement, according to Linda Smith, Lingle's policy adviser.

Not only does the Malulani proposal have the support of Lingle, a former two-term mayor of Maui, but was endorsed last year by then-Mayor Alan Arakawa and is urged now by newly elected Mayor Charmaine Tavares. Maui is the only major island that relies on one state-run hospital for its entire health care.

This bureaucratic quagmire that has stood in the way of the Malulani hospital is likely to recur in future years if the certificate-of-need process is not changed. Lingle is right in saying the change is needed "so that other communities do not have to suffer the same setbacks in attempting to bring modern medical facilities into their communities."

CORRECTION

Thursday, February 1, 2007

» An editorial on Page A10 Monday incorrectly stated that Malulani Health Systems' partner in proposing a new hospital at Kihei on Maui is a Texas-based nonprofit. Triad Hospitals Inc., the company to which the editorial referred, is a for-profit company.